Skip to main content
SpringerLink
Log in

Choice of surgical approach for capitellar fractures based on pathoanatomy of fractures: outcomes of surgical management

  • Original Article • ELBOW - FRACTURES
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

The understanding of the anatomic configuration of the fractures of the capitellum has enhanced in the last few years, and the classification of these fractures continues to evolve. It is essential to tailor the surgical approaches to these fractures based on the state-of-the-art classifications. Thirty-three patients with fractures of the capitellum were included in this retrospective study. The mean age of the patients was 37.9 years, and the mean follow-up period was 24.6 months. Seventeen patients had Bryan–Morrey type I fracture, three had type II fracture, two had type III fracture and eleven had type IV fracture. Of the 11 patients with Bryan–Morrey type 4 fracture, 5 patients belonged to Dubberley 2A and 3A category and 6 patients belonged to Dubberley 2B and 3B category. Bryan–Morrey type 1, 2 and 3 fractures were approached via extended lateral approach. Bryan–Morrey type 4 was further classified using the Dubberley classification. Dubberley 2A and 3A fractures were approached via the anterolateral approach, and Dubberley 2B and 3B fractures were approached via the posterior transolecranon approach. Fracture united in all patients. Three patients showed slight delay in union, but union was achieved eventually. Two patients had avascular necrosis of the capitellar fragment. The mean range of flexion/extension was 133° (SD ± 8.0°), and pronation/supination was 151° (SD ± 6.7°). The mean Mayo Elbow Performance Index at final follow-up was 80.9 (SD ± 13.9). Based on the MEPI score, 14 patients had excellent, 10 patients had good, 6 patients had fair and 3 patients had poor results (Dubberley type 3B fractures). Correct choice of surgical approach facilitates the accuracy of reduction and fixation of these difficult fractures. It also helps to minimize the requirement of two-incision approach. Anterolateral approach is an excellent approach for Dubberley 2A and 3A fractures.

Level of evidence: Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Cheung EV (2007) Fractures of the capitellum. Hand Clin 23:481–486

    Article  PubMed  Google Scholar 

  2. Bryan R, Morrey B (1985) Fractures of the distal humerus. In: Morrey B (ed) The elbow and its disorders. WB Saunders, Philadelphia, pp 325–333

    Google Scholar 

  3. Elkowitz SJ, Polatsch DB, Egol KA, Kummer FJ, Koval KJ (2002) Capitellar fractures: a biomechanical evaluation of three fixation methods. J Orthop Trauma 16:503–506

    Article  PubMed  Google Scholar 

  4. McKee MD, Jupiter J, Bamberger H (1996) Coronal shear fractures of the distal end of the humerus. J Bone Jt Surg Am 78-A:49–54

    Article  Google Scholar 

  5. Ring D (2009) Open reduction and internal fixation of an apparent capitellar fracture using an extended lateral exposure. J Hand Surg Am 34-A:739–744

    Article  Google Scholar 

  6. Dubberley JH, Faber RJ, MacDermaid JC, Patterson SD, King GJ (2006) Outcome after open reduction and internal fixation of capitellar and trochlear fractures. J Bone Jt Surg Am 88-A:46–54

    Google Scholar 

  7. Ruchelsman DE, Tejwani NC, Kwon YW, Egol KA (2009) Open reduction and internal fixation of capitellar fractures with headless screws. J Bone Jt Surg Am 91-A(Suppl 2 (part 1)):38–49

    Article  Google Scholar 

  8. Mighell M, Virani NA, Shannon R, Echols EL Jr, Badman BL, Keating CJ (2010) Large coronal shear fractures of the capitellum and trochlea treated with headless compression screws. J Shoulder Elbow Surg 19:38–45

    Article  PubMed  Google Scholar 

  9. Goodman HJ, Choueka J (2005) Complex coronal shear fractures of the distal humerus. Bull Hosp Jt Dis 62:85–89

    PubMed  Google Scholar 

  10. Bilsel K, Atalar AC, Erdil M, Elmadag M, Sen C, Demirhan M (2013) Coronal plane fractures of the distal humerus involving the capitellum and trochlea treated with open reduction internal fixation. Arch Orthop Trauma Surg 133:797–804

    Article  PubMed  Google Scholar 

  11. Ring D, Jupiter JB, Gulotta L (2003) Articular fractures of the distal part of the humerus. J Bone Jt Surg Am 85-A:232–238

    Article  Google Scholar 

  12. Sano S, Rokkaku T, Saito S, Tokunaga S, Abe Y, Moriya H (2005) Herbert screw fixation of capitellar fractures. J Shoulder Elbow Surg 14:307–311

    Article  PubMed  Google Scholar 

  13. Imatani J, Yoshiaki M, Hiroyuki H, Hajimi I (2001) Internal fixation for coronal shear fractures of the distal end of the humerus by anterolateral approach. J Shoulder Elbow Surg 10(6):554–556

    Article  CAS  PubMed  Google Scholar 

  14. Giannicola G, Sacchetti FM, Greco A, Gregori G, Postacchini F (2010) Open reduction and internal fixation combined with hinged elbow fixator in capitellum and trochlea fractures. Acta Orthop 81:228–233

    Article  PubMed  PubMed Central  Google Scholar 

  15. Yari SS, Bowers NL, Craig MA, Reichel LM (2015) Management of distal humeral coronal shear fractures. World J Clin Cases 3(5):405–417

    Article  PubMed  PubMed Central  Google Scholar 

  16. Malki AA, Salloom FM, Wong-Chung J, Ekri AI (2000) Cannulated screw fixation of fractured capitellum: surgical technique through a limited approach. Injury 31:204–206

    Article  CAS  PubMed  Google Scholar 

  17. Hoppenfield S, DeBoer P, Buckley R (2009) The elbow. In: Hurley R, Wolfberg E, Murphy D (eds) Surgical exposures in orthopaedics. Wolters Kluwer/Lippincott Williams and Wilkins, Philadelphia, pp 122–127

  18. Morrey BF, An KN, Chao EYS (1985) Functional evaluation of the elbow. In: Morrey BF (ed) The elbow and its disorders. WB Saunders, Philadelphia, pp 73–91

    Google Scholar 

  19. Broberg MA, Morrey BF (1986) Results of delayed excision of radial head after fracture. J Bone Jt Surg Am 68-A:669–674

    Article  Google Scholar 

  20. Brooker AF, Bowerman JW, Robinson RA, Riley LH (1973) Ectopic ossification following total hip replacement. Incidence and method of classification. J Bone Jt Surg Am 55-A:1629–1632

    Article  Google Scholar 

  21. Nauth A, McKee MD, Ristevski B, Hall J, Schemitsch EH (2011) Distal humeral fractures in adults. J Bone Jt Surg Am 93-A:686–700

    Article  Google Scholar 

  22. Lee JJ, Lawton JN (2012) Coronal shear fractures of the distal humerus. J Hand Surg Am 37:2412–2417

    Article  PubMed  Google Scholar 

  23. Alvarez E, Patel MR, Nimberg G, Pearlman HS (1975) Fracture of the capitulum humeri. J Bone Jt Surg Am 57-A:1093–1096

    Article  Google Scholar 

  24. Guitton TG, Doornberg JN, Raaymakers EL, Ring D, Kloen P (2009) Fractures of the capitellum and trochlea. J Bone Jt Surg Am 91-A:390–397

    Article  Google Scholar 

  25. Cornelius AL, Bowen TR, Mirenda WM (2012) Anterolateral approach for an unusual pediatric capitellar fracture: a case report and review of literature. Iowa Orthop J 32:215–219

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics, HOSMAT Hospital, McGrath Road, Bangalore, 560025, India

    M. R. Ravishankar, Malhar N. Kumar & Rishikesh Raut

Authors
  1. M. R. Ravishankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Malhar N. Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rishikesh Raut
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Malhar N. Kumar.

Ethics declarations

Conflict of interest

There are no conflicts of interest, and authors have not received any funding in support of this study.

Informed consent

Obtaining the informed consent from involved patients was waived by the research ethics committee (or institutional review board).

Human rights statement

All procedures involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments.

Ethics committee

The study was approved by the research ethics committee (or institutional review board).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ravishankar, M.R., Kumar, M.N. & Raut, R. Choice of surgical approach for capitellar fractures based on pathoanatomy of fractures: outcomes of surgical management. Eur J Orthop Surg Traumatol 27, 233–242 (2017). https://doi.org/10.1007/s00590-016-1877-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-016-1877-5

keywords

Search

Navigation